Expansion of Coverage Under the Affordable Care Act

6/13/2015

Access to quality health care for you and your family is influenced by a number of factors that include your insurance status, income, race, gender, age, and where you live. The Affordable Care Act (ACA) attempts to address inequities or special considerations in these areas to make comprehensive and affordable health insurance coverage available to more people.

To accomplish this goal, provisions of the ACA were written to expand coverage to more Americans by:

Increasing the number of people covered by Medicaid,

Creating a competitive marketplace for comparing and buying coverage, and

Raising the age limit to 26 for adult children covered by their parents' insurance plans.

Medicaid Expansion

Medicaid is a state-administered assistance program that uses federal and state funds to reduce or pay medical bills for eligible low-income people. Eligibility is based on an individual’s or family’s income as a percentage of the Federal Poverty Level (FLP), a benchmark that is updated every year. Prior to the passage of the ACA, Medicaid provided assistance to eligible low income:

Pregnant women,

Children under the age of 19,

People over 65, and

Those who are blind, disabled or who need nursing home care.

In addition to these groups, the ACA increases the number of people eligible for Medicaid by including adults without children and raising the maximum income for eligibility. But not all states have approved this expansion. (Click here and select “Get State Information” near the bottom of the page to find out if your state is expanding coverage.) The Supreme Court ruled that each state has the right to decide if it will expand its Medicaid programs.

If you live in a state that is expanding coverage, Medicaid covers adults under age 65 who make less than 133 percent of the Federal Poverty Level (FPL). (In 2013 that was approximately $15,800 for an individual and $32,000 for a family of four.) Click here to find out if you might qualify for Medicaid based on your income and the size of your family. But keep in mind, the cost of coverage can still vary from state to state based on how the coverage is provided.

If you live in a state that is not expanding Medicaid coverage and you are not already receiving benefits, you may still want to apply in case you qualify in your state under the existing rules. Your state may also opt to expand Medicaid in the future.

Health Insurance Marketplace

Another way the ACA makes health insurance available to more people is by making it available from federal and state marketplaces, where private insurance companies can compete for your business. The marketplaces give you an opportunity to review and compare plans, creating an incentive for insurance companies to keep premiums low and more competitive with other plans, including group plans.

Some states have their own marketplace while others are run by the federal government. Click here to learn more about the health insurance marketplace and how it works. To visit the Health Insurance Market, begin at the federal website by clicking here.

So, if you aren't already covered by insurance through your employer, Medicare or Medicaid - say, for example, you are self-employed or between jobs—the marketplace is intended to help you find affordable, comprehensive coverage that includes preventive care.

Tax Credits and Subsidies

Some people have too much income to qualify for Medicaid but not enough to manage the premium payments available from plans purchased through the exchange. The ACA provides subsidies and tax credit for this group to help them afford coverage.

If your family income is between 100 percent and 400 percent of the federal poverty level (approximately $23,050-$92,200 for a family of four in 2012), you may qualify. These tax credits will lower your total tax bill, but they can also be used before tax time to reduce your premium payments, copayments, co-insurance and deductibles.

If you are still unable to afford coverage, you may be eligible for sliding scale subsidies. The Henry J. Kaiser Family Foundation offers a handy tool for calculating your eligibility for subsidies based on income level, age, family size and regional costs.

If after reviewing your options you decide not to get coverage, you may face penalties or fines. Click here for more information on the penalty.

Coverage for Adult Children

Prior to passage of the ACA, most health insurance policies covered children on their family's health insurance policies until they turned 18 or 19, or 22 or 23 if the child went on to attend full-time college after high school.

The ACA expanded coverage for these adult children, which may include stepchildren, adopted children and foster children, by allowing them to join or remain on the family policy or group plan up to age 26. Your child does not have to be in school, live at home, be single or qualify as a dependent. In fact, your adult children may even stay on your policy if they can get health insurance through their employer.

Finding the Right Coverage for You and Your Family

Visit http://www.healthcare.gov/ to learn more about your options for coverage under ACA and to enroll in plans offered in the Marketplace. If your state has its own website for its health insurance marketplace, the federal website will redirect you to your state website.

Note: This website and the information contained, expressed or implied herein are made available solely for general informational purposes and are not intended to be legal, tax, health, medical or professional advice or the sole source of information about health insurance coverage or specific health plans. While every effort is made to ensure that this information is accurate and current, SCAI makes no guarantees and disclaims any expressed or implied warranty or representation about its accuracy, relevance, timeliness, completeness or appropriateness for a particular purpose.

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